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General NPI Number Information
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NPI Number | 1497153944
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Entity Type | Organization
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Legal Business Name | PAIN CENTERS OF AMERICA, LLC
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Dates
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Enumeration Date | 12/16/2014
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 9100 EAST RAINTREE DRIVE SUITE 248
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City | SCOTTSDALE
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State | AZ
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Zip | 85260
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Country | US
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Telephone | 412-477-4493
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Fax |
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Provider Business Mailing Address
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Address Line | 9100 E RAINTREE DR SUITE 248
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-2762
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Country | US
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Telephone | 412-477-4493
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY GEORGE THEOFILIS
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Credential | DO
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Telephone | 412-477-4493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | OS015718
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 006356
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License Number State | AZ
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